Which finding is most typical of bacterial keratitis?

• A. Dendritic lesions on fluorescein staining.
• B. Hazy cornea with an ulcer and purulent discharge.
• C. Normal cornea with mild conjunctival injection.
• D. Severe photophobia without discharge.

Answer: (B)

Bacterial keratitis presents with a hazy cornea due to edema and an actual corneal ulcer, often with a purulent discharge from the invading bacteria. This combination reflects direct infection of the corneal tissue and surface, causing rapid inflammation and epithelial disruption. The haziness comes from corneal edema and infiltrates, while the ulcer represents an epithelial defect with underlying stromal involvement. In contrast, dendritic fluorescein staining is characteristic of herpes simplex keratitis, not bacteria. A normal cornea with only mild conjunctival injection points away from keratitis, and severe photophobia without discharge is less typical for a bacterial ulcer. The presence of a corneal ulcer with purulent discharge is the hallmark feature that identifies bacterial keratitis and signals the need for urgent ophthalmologic care and prompt topical antibiotics.